Cholestatic Hepatitis Induced by Epstein-Barr Virus in a Pediatric Population

Abstract

Objective: We present 5 cases of Epstein-Barr virus (EBV)-induced cholestatic hepatitis (CH) and review all additional pediatric cases from the literature.

Design: The medical records of 5 patients with EBV-induced CH were reviewed. A comprehensive review of the literature was performed.

Results: Including our patients, a total of 17 patients with EBV-induced CH were reviewed. The average age was 11 years (range 1-18 years); male to female ratio was 0.9:1. The most common presenting symptoms included fever, jaundice, and cervical lymphadenopathy. However, a significant number of patients presented with jaundice alone, without other suggestive signs of an EBV infection. Hepatocellular enzyme levels were significantly higher than in classical infectious mononucleosis. In many cases, serum alkaline phosphatase was also elevated, accompanied by direct hyperbilirubinemia.

Conclusion: EBV infection should be included in the differential diagnosis of CH in all age groups. In the vast majority, full recovery is expected.

Keywords: Epstein-Barr virus; cholestatic hepatitis; infectious mononucleosis; jaundice.